A Twisted Trail

The first post in this series asked if a pigeon toe was friend or foe.  It is certainly a strategy, an adaptation that has a purpose.  For me, my half with the pigeon toe also carried my biggest problems, particularly with that knee and that half of the pelvic floor.  From foot to head, that side had made alterations to compliment the other.  In doing so, it left itself vulnerable.  The development of a twist counter to biomechanical function (heel out vs. heel in) created a “stop” side that halted movement instead of allowed it.

Up Leg

My turned in leg is my up leg.  It hinges instead of squats.  The hip likes to stay high.  This side is excellent at popping out of movement laterally, because it’s a stopper.  When trying to push me forward off of this leg when it is back, the heel struggles to turn in and stay in, preferring instead to ‘bounce’ in and out of position (see :07 sec mark in video below):

(Left leg has nike logo.  Camera was flipped.  I was trying to turn the foot in on both legs forward to see what might happen elsewhere.)


Foot Axis – Fifth Met vs. First Met

A pigeon toe uses the fifth metatarsal or outer ball of foot by which to rotate around.  An ‘untwisted’ lower leg uses the first.  Biomechanically speaking, the first offers more sound and strategic options to coordinate movement up the chain.  The metatarsals and the MTP joints are intertwined.  Use of the fifth met or outside of foot only grants you access to the outer MTP.  Alignment through the first grants you both.  [See the excellent comment left on the last post where the observer further breaks this down.)

  How the foot is placed is connected to hamstring use.  (Left leg being manipulated.)


Externally Rotated Hip

Because the point of contact and pivot is at the fifth metatarsal, the hip is externally rotated to accommodate.  Following the hip, the tibia sits more externally, which was counter to my assumptions that an inward foot would have an inward tibia.  The curve or angle lies primarily within the foot itself, with slight visible adjustments carrying over into the ankle.


Standing Center Shifted Left

If you’ve ever noticed a pigeon-toe gait, the twisted foot always crosses the midline.  When both feet are pigeon toed, both feet swing over the midline in an overlapping fashion.  Weight seems to follow the direction of the greater heel turn, and my central axis shifted left as the twisted foot pulled things into it.  (Note what hip you sink into when ‘waiting or resting’ when standing.) It also pushed that left hip forward, which aligns withy my ‘about to run’ stance and sets up a stability side.


Pelvic Floor & Seated Center Shifted Right

That left stable hip sits higher as well.  No drop, no squat, no pelvic floor to press down against.  When sitting, I load the right side that has a working pelvic floor.  I can move into it, whereas the left hip flexor prevents me from getting deeper internally (and reflexively).



The knee on my twisted foot side had a non-contact ACL tear in 2005.  I am not assuming causation, just stating fact.  (The entire body is a testament to the chicken or the egg conundrum, and we can only follow what we are aware of, in the time frame that awareness exists.)  The reconstructive surgery I had the following year used part of my semitendinosus tendon from that leg to re-create a new ACL.



BodyParts3D/Anatomography, CC BY-SA 2.1 JP <https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en>, via Wikimedia Commons


See that curved wrap around that tracks toward the inside of the knee?  Lessen that left red line and all the hip changes make sense.  But here was the big surprise — that left leg still uses the hamstrings as the primary knee flexor, but the right uses the calf.  One would think that  the left would use the calf option (since its hamstring got cut/ changed), but the opposite happened.  Perhaps the twisted foot keeps the calf engaged, or maybe it was the upper-lower leg connection that the surgery manipulated, but I did not expect my right hamstring to be more dormant than my left.

That Pesky Knee

Putting things all together, the lingering issues with my left knee aren’t from the surgery but from the excessively oppositional torsions running through the leg.  The medial knee becomes the pinch point due to a lack of compliment.  Foot twisted in, load on the fifth met, a tibia that struggles with internal rotation, a femur that is externally rotated, a hamstring that is outer dominant, a pelvis that is shifted forward, and a hip that sits high with a minimal pelvic floor.  The pain is from a lack of space around the inner edge of the tip of the tibia is because that first met line sits short.  More peroneal length, less post tib.



Still from IG above.


Same twist with knee bent and hip flexed.


This translates to a lack of space in my left knee to let the shin roll medially (ankle drops):

(Camera remains flipped.  Right leg with dropped ankle shown first.)


The right knee has multiple hinge points instead of just one.


To undo or unravel these held tension lines, I could examine them piece by piece or try to progressively check each one and expand into the next.  One example of what this might look like is the following, which made my knee feel like butter afterwards:



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